Going to the GP about self-harm

When parents and carers realise that a young person is harming themselves or having mental health problems they often seek support through their general practitioner (GP). The GP can refer them for further health service care if necessary. Some of the people we spoke to found their doctor very helpful, but others had mixed experiences.

GPs were praised by several parents and carers. Liz’s GP was ‘just lovely’; Pat and Jo both thought their GPs were ‘fantastic’. ‘I can’t stress enough that your first port of call has to be your GP and you have to get a GP that’ll listen to you,’ Audrey told us. ‘You have to get a GP that will sympathise, and want to be able to help you’. She described her husband’s current doctor as ‘phenomenal’.

Pat is divorced and looks after his three children aged 15, 13 and 11. He works as a builder. Ethnic background: White.

And has the GP been helpful and supportive at all?

We haven’t been back since we went in but he was absolutely fantastic. We phoned, somebody advised us to phone and say, “Can we come in?” “Yep.” We walked in and they said, “Two seconds, don’t take a seat.” And I hadn’t even said who I was. He came out and took us in, even though there were other people there, and I think we were with him forty five minutes. We are very, very lucky in that he is fantastic anyway, absolutely fantastic, magnificent bedside manner, absolutely cares but he was fantastic. I do think he did ask to see [my daughter] again in about a month, which will have passed, but, at the time, I don’t think I was taking in any more information but I certainly left there thinking we could always go back.

But I would never bother him with how I felt, I’ve got to be honest. But he was fantastic, couldn’t have couldn’t have wanted more. I was, with the pressure they’re under and it’s always in the news and, “Oh god, I phoned in November for an appointment and got one in July.” They were waiting on us literally. They made no drama, no fuss, we didn’t feel odd and we just went straight in and I did say to her, I said, “You have got people waiting.” “Don’t worry.” He said, “There’s other doctors on. Don’t worry.”

And it was first class, absolutely first class, not a qualm there at all. You could say, well, perhaps he should have phoned us up as the month has gone by but we have to stop being a nanny state, at some point, don’t we. You know, I haven’t felt the need to take [my daughter] back there.

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Female

Background:

Jo, 53, is married with two daughters aged 25 and 22. She is a nurse. Ethnic background: White British.

On the occasion with the first sort of cycle, as I tend, the first episode, when I went down to the doctor’s surgery that Monday morning at eight o’clock, and I stood in front of the receptionist and I must have looked like a bag of rags and I said to her, “I think my daughter needs a mental health section.” And she sort of lent across the counter and touched my arm and said, “Do you want to come at quarter past eight?” So I literally, came home, dragged her out of bed and marched her down to the doctors and the GP that we saw has a little special interest in mental health, although she’s a woman GP so she tends to get the woman’s things, she was fantastic. And she was also very good in that she supported me and, at one time, gave me some sick certification from work so that I could have some time because I was trying to work but be at home. So I was maybe saying to my colleagues at work, “Look, if I come in and work first thing in the morning and [my daughter] is going to be asleep because her antidepressants are knocking.”

Yeah. It’s all right.

“If my daughter is going to be asleep and the antidepressants are knocking her out and my other daughter is going to be here, we can keep her locked in her room.” Which sounds really Victorian, “Until I can get home at lunchtime and then my husband will be home at six so I can come back at six.” And I was run ragged because I was trying to do a full time senior job and do community mental health caring for my daughter. So I found the GP very supportive. She was also very supportive in that she would ring the house, which maybe she wasn’t supposed to do.

But to see how we were doing. She was very discreet with [my daughter], sorry, she was very discreet with my daughter in the surgery. She would let us use a side door so that we didn’t have to go through the waiting room.

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Age at interview:

30

Sex:

Female

Background:

Audrey is 30 years old, married with two children. She works as a manager in a bookmaker’s. Ethnic background: White Scottish.

And we finally got our GP and he was a superstar, he really was. So much so that he is now our family GP and he actually listened. He read through all my husband’s notes, all his past, all his previous medications. He listened to what we wanted. He listened to our stories. He listened to our past experiences. He listened to the health services that we had tried to get into, over in Northern Ireland as well as over here and he helped. He did. He helped. He listened to us, both sides, you know my husband’s side as well as my side, he looked at the family setting, you know, and he didn’t make any assumptions. He didn’t make any judgments. He could see that my husband wanted help. He could see that my husband was, he was addicted to diazepam. He’d had six years of constantly using diazepam and we’re talking up to a hundred and fifty milligrams a day he was taking and he had looked at all his medication that he was on at that time, and he started a regimen of weaning so we were gradually, coming off all the pills.

A few parents were reluctant to contact their GP. Sarah Z told us: ‘I suppose the missing bit is the GP, which we bypassed completely. That was really me being anxious about labelling her and getting her into a sort of system, where I felt that she didn’t need that kind of attention. She needed practical help and that’s what I wanted to get her straight away.’ On the advice of the school nurse Sarah arranged for her daughter to see a private psychologist. Jackie didn’t want details on her daughter’s records, and she had a low opinion of GPs.

Jackie, aged 40, is married with two children. She is a care worker. Ethnic background: White/Scottish.

I’m interested to hear a bit more about why you didn’t visit the GP.

I thought pills. My immediate thought was, “She will get put on a waiting list to see a counsellor. We’ve not got time to wait around for this. I want to see someone right now.” And then she ended up changing her mind when I sorted it anyway. So there was a part of me that would be, I did suggest to her, I did put that idea over it was very much, “I could make an appointment. She probably won’t go.” So there was a bit of that as well, there was a bit of that as well. Me personally, do you know what as well actually? which is really quite horrible, I’ve always been a carer and I didn’t want anything on her, you know, you have these medical things and they’re on your records, I didn’t want any of that, I didn’t want any of that.

And at the time I was applying to be a day carer for social work as well, there was a bit of that going on as well. And also the main thing really was pills. I think there’s better ways than pills. I didn’t want, I thought, “We’ll go to the GP and they’ll say, ‘Right, oh, she’s depressed. There’s some pills.’” Her body changes and everything, you know, I didn’t want it interfering with that. I wanted, I, I like things to be natural. I’m not the sort of person that takes pills with a, a headache either. I’m funny like, I’m funny like that. I didn’t want her on pills, that’s definitely the main reason, and I didn’t want her put on a list of a hundred people to wait to see a counsellor. And she was dodgy about going, she was very flaky at that point, she wasn’t ready, she wasn’t ready for help ultimately.

And GPs are useless, I think they’re crap, to be honest. In dealing with that, I don’t think that they’ve got the training, they’ve not got the right training to deal, they don’t understand, they’ve not got the empathy, understanding. They, they, they don’t get it, they just don’t get it and so they just, “Right, okay, we’ll put you on a list.” And they’ve not got the time. They’ve got five minutes. You know, we’re having a, a crisis here. They’ve got five minutes, you know, “Get out, there, there’s a prescription, on you go.” They’ve not got the skills to deal with it or the time. So quite a few different reasons, quite a few different reasons, yes, I would never use GPs, you know. Unless I’ve got pneumonia or something you know, or I need signed off, which is just what I done with my mum, you know.

But even then, even then, you know, I’m grieving, you know, my mum had died in my arms, I’ve turned up the next day, you know, and “ I need signed off, my mum died in my arms yesterday.” “Well, do you want some sleeping pills?” I’m like, “I want signed off, I don’t want sleeping pills.” “Are you sure, are you sure?” There’s too much of that pill culture going on. No, actually I’m sleeping fine, you know. Which I was, with the stress and everything you know. But they’re too, they’re not equipped enough. I didn’t want them dealing with my daughter. I didn’t want my daughter telling them and they’re, and they’re not interested because they’ve not got the time. She, we wouldn’t have had enough time to explain. I think it’s too serious an issue to give it five minutes and to explain, this is what’s really happening for me . They’re not counsellors. That’s the last person really I, that I would have seen , yes. I mean it wasn’t the per-, first person I thought about going to at all. That was like a total last resort, “If we can’t get a counsellor, if we can’t afford it, yes, we’ll see if we can get one from your GP.” But I didn’t want anything to do with GPs, yes. You can’t rely on them. Which is unfortunate, you know.

Sometimes the young person themselves decided to consult the GP. Dot’s teenage daughter went independently to her doctor, who advised her to tell her mother about her self-harm. Dot said ‘the GP must have been brilliant’ as her daughter was then able to talk about her problems. Bernadette felt excluded because her son was old enough to see the GP as an adult and wouldn’t let Bernadette go in with him.

Parents were not always satisfied with GPs' decisions about involving mental health services for their children. Charles had reservations about this: the doctor was ‘so concerned with his [Charles’s son’s] mental state that she, without reference to us, which is something we rather disagree with, referred him to the crisis centre of CAMHS [Child and Adolescent Mental Health Service].’ By contrast when Susan Y asked her doctor to refer her daughter to CAMHS he refused because he didn’t think she was mentally ill. Alexis was told by her GP that he couldn’t prescribe medication for her 16 year-old daughter, but the waiting list for psychiatric treatment was very long. He gave Alexis contact details for an expensive private psychiatrist. Jane Z had a ‘very good sort of old male GP, very bluff and practical’, who said it was too early to go down the CAMHS route and advised in-school counselling instead. Jane thought this was the right decision.

A few parents talked about unfortunate encounters with GPs. Although Jane S’s doctors were usually helpful she thought they were ‘completely stumped’ by her daughter. Susan Y felt her GP ‘had absolutely no idea about young people’.

Jane is 54, married with three children. She is director of a charity. Ethnic background: White British.

We went to the doctors quite a bit and they weren’t very helpful. I have the most fantastic doctor’s surgery but and they’re very helpful with lots of other, you know, issues but on this one they were completely stumped, to be honest. They photocopied some things from the internet for her. I went and had a chat with my doctor, who I knew was going to be seeing her, because she was still quite young. She was only sixteen. I know she had rights of confidentiality so I thought, “Well, I won’t.” “I’m not trying to ask for information.” “I’m going to give information.” Which I thought I’d done quite successfully but unfortunately, they wanted just to talk to her and kind of shut me out of the process really and I can see why but I didn’t think it was very helpful. I needed support and I also needed to inform them of things that I thought would be really important for them to know. One of the doctors at the surgery actually said to me, “Is she a nice teenager?” As if only sort of, you know, horrible teenagers self-harmed and I found that really distressing actually.

So, equally, she found it very distressing that she had given her just a lot of photocopies about anger and anger management and, as she said, you know, she wasn’t angry. She’s not an angry person. She wasn’t self-harming out of anger. She was, it was far more complex than that and she felt she was dismissed really.

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Age at interview:

47

Sex:

Female

Background:

Susan is a 47 year old social worker. She lives with her partner and their daughter. Ethnic background: White British.

So I took her to the GP to get the a referral to CAMHS. Went to the GP and explained to the GP what was happening and he said, “Can I have a look at your arms.” So she showed him. By this time, I’d got her some antiseptic cream and they weren’t deep. They were superficial. They weren’t needing treatment. To what the GP turned round and said to her, “I can’t believe that you’ve done this. It’s about time you grew up. You’re immature, you know. You’re supposed to be a mature girl. You’ve got a good parent, you know. Talk to your parent and just stop attention seeking.” And he said, I said, “So I’d like a referral to CAMHS.” He said, “I’m not prepared to do that.” He said. “Because she’s not mentally ill and there’s a counsellor that comes to the GP surgery and he’s an elderly gentleman in his in his sixties like me.” And coming out and I said, “Oh will you make a referral there then please.” And coming out she turned round and said, “Does, he has absolutely no idea has he about young people.” And I said, “No, you’re right. He doesn’t.”

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Age at interview:

37

Sex:

Female

Background:

Debbie, aged 37, is married with three children aged 16, 14 and 12. She works part-time as a midwife. Ethnic background: White British.

My daughter has been self-harming for many years. She’s sixteen now but the self-harm started about aged eight or nine but, at the time, as a family, we didn’t realise it was self-harm. We thought it was a phase she was going through because her granddad died and she started head banging and pulling her hair out and we thought it was to do with stress. We got to when she was in year six, so she would have been about ten or eleven and we started noticing it was happening more and more. Took her to the GP, the GP dismissed it and said, there wasn’t a problem, it was a phase and it’s bereavement and just keep talking about it, which we did do.

And then by Christmas, she’d lost a massive amount of weight and she started looking really ill and I said to her, “This isn’t right.” I went to the GP and said, “I want her referred. I’m not happy with what’s going on.” At that point, the OCD and the self-harm was linked as well. I could see them two were linking and he said he’d put a referral in.

It got to February two thousand and twelve, she’d now lost three stone and she was fainting and I went back to the GP and said, “I haven’t heard anything. I’d read on websites that eating disorders should be seen quite quickly in mental health services and I’ve not heard.” He said, “I’ll put another referral in.” He put another referral in and, at that point, I just wrote to the MP and said, “Look, I’m watching my daughter die. You’ve got to help me.” I wrote the letter and within four days, the CAMH service phoned me up and she said, “I’m really sorry but your GP put the referral in wrong. He put it in as OCD and didn’t mention the eating disorder, which is why she was at the bottom of the list.” I said, “No, it’s the eating disorder.”

It is important to find a sympathetic GP you have confidence in. This may be easier in GP practices where there are several different doctors. Audrey and her husband saw many GPs before they found one who was helpful. ‘We went through so many GPs that have just passed the buck with more tablets and more tablets and more tablets and it’s a vicious circle. It’s not helping the situation,’ Audrey told us. ‘If you’re not happy with whoever it is that you see and you want a second or a third or a fourth or a fifth opinion, if you have to go through every GP in that practice, you do it.’

Erica, age 48, is divorced with two daughters age 20 and 17. She works as an administrator in children’s social care. Ethnic background: White European.

And how about your GP? Is he or she supportive or?

Well, yeah, it was our GP who first spotted that she was depressed. Well, when I first took her took her to a doctor, we saw a GP twice and both times he said, “It’s her age. She’ll grow out of it.” And I can sort of understand that but actually, I was very cross by the end of it because I didn’t feel that he actually listened.

The other GP that we saw, who was actually the GP we’re registered with because, you know, we’re registered with a health centre so we happened to see somebody but I then went to see somebody else, who I’d seen myself before, and she said, “I think you’re depressed so you need counselling.”

But, by then, it was too late because it was a few days before she overdosed.

Yes.

And but she was fantastic because when, apparently, she was rung up when my daughter was in intensive care to be told what happened and I was told that she was quite shocked, shocked silence at the other end. When she was discharged by the hospital, the GP rang me and said, you know, “Come and see me.” So I made an appointment but that was the day that she was then admitted to the inpatient unit and she called me again, having received a fax from the inpatient unit [sniffs]. And she was amazing, she’s been amazing throughout.

To me and to my daughter.

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Age at interview:

58

Sex:

Female

Background:

Susan, 58, is married with two daughters aged 23 and 25. She is a part-time librarian. Ethnic background: White British.

We took her along to the doctor, you know, because we obviously realised there was something emotionally, you know, wrong and she needed some help.

And I was very disappointed when, as was she, with the response of the doctor. I think I got the impression that the doctor was, well, I know this doctor is particularly good with dealing with people with depression. She’s been really good with my neighbour, who had who had problems, and she spotted it and she helped her and she did a really good job. But her response with my daughter, was just to tell her off. She just said, “Oh, you mustn’t do that. You mustn’t cut yourself. You know, you’re going to leave scars and when you get older, you, how do you think you’ll feel about that?” And I know [my daughter] was absolutely furious. Yes. I know my daughter was really furious about that.

Yes.

And but she did organise for us to go and speak to a counsellor so we all went along to to that and she seemed very good and [my daughter], my daughter felt, my daughter seemed quite comfortable with that.

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Age at interview:

49

Sex:

Female

Background:

Jane is married with two daughters aged 15 and 17. She works from home helping manage her husband’s business. Ethnic background: White British.

We had, we had a very good sort of older male GP, who [my daughter] spoke to, who my daughter spoke to, very early on, that year seven, year eight bit. Now he was, he was a real, bit of a dour Scot, very bluff and blunder about it, practical, which was great, and he said, “Don’t go the CAMHS route, too soon for that, you know, suggest.” And, I think he was, he was the one that put us into this in-school counselling. Sort of suggestion.

Yes.

Which was the right route. When things came up again a little bit later, he’d retired and there was a young male GP who, again was very good, and he sort of said, “Look, you know, do come and see me.” But, it is this business of there has to be a trusting relationship, and, you know, young people don’t see their GPs very often, and GPs aren’t in the community the way they used to be.

Yes, yeah.

So, you don’t just go and knock on the door and say, which you did when we were younger, you know, the GP was just always about. You saw them didn’t you?

So, from that point of view, I suppose the GP just wasn’t familiar enough, or accessible enough, from that point of view. We needed, for her to do the Africa trip, to get a medical physician’s release form.

So, we did, actually, have to go to see the GP, and, obviously, my daughter was quite, was focused on going on the trip, at that stage, so there was a reason to go and do that. And we had a chat with a lady GP, who was absolutely brilliant. Because I thought, I’m going to go in here, she’s going to say, “Oh yeah, I’ll sign that. That’s fine. Off you go.” She hadn’t, and she’d actually, looked back over all of the notes before we went in. She’d looked at all of the copy correspondence that had been going on, and she just looked at [my daughter], and she said, “Blimey, this sounds like a good trip, so tell me about it.” And, we were in there for fifteen, twenty minutes. She spent time with her, and, just talked her through it, because, of course, my first impulse was, she’s never going to sign this form. And, she just sort of said, “Look, if you think you can do this, then that’s fine.” And, at that stage, I was trying to think in terms of booting the CAMHS bit as far away as possible, and I just sort of said to her, “Look, you know, one of the things that we’re really struggling with, is that we need somebody that [my daughter] can talk to.”

“If she feels that she wants to come back to you, and, and just talk things through again, is that okay?” And she said, “Absolutely, anytime.”

Great, yes.

And coming away, sort of said to my daughter, “Well, you know, what do you think? Do you think she is somebody you could talk to?” And she said, “Yeah, maybe.” Which actually was a, you know, off the top of the scale reaction, at that stage. So that, is, something, which is a kind of a fledgling

Yes.

Relationship, but again, she’s only available when you get an appointment. She’s only available, you know, restricted times a day, when my daughter is probably supposed to be at school. It’s just, it’s like the sort of the, all of the warnings that they gave us when we first went to CAMHS, it’s only there at a particular time, not necessarily when you need it.

And that’s what we need, is somebody who, you know, is there when you need it, just to off load, and say, “Look, I’m feeling really bad.” And they can respond immediately, and just say, “Yeah, and look, I’m thinking of you. We’ll talk properly in the morning.”

Last reviewed December 2017.

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